Strengthening Eating Disorder Prevention and Care for First Nations Peoples in Australia
In this blog, researcher Zyana Gall discusses their paper Culturally responsive recommendations for eating disorder prevention and management for First Nations peoples in Australia: a policy scoping review.
Eating disorders (EDs) are a serious health issue across Australia, but little is known about their impact in Aboriginal and Torres Strait Islander communities. Emerging evidence suggests First Nations peoples may be at higher risk, but mainstream care is often culturally unsafe, and research remains scarce.
Our recent policy scoping review aimed to critically examine the current state of knowledge regarding the prevention and management of EDs in First Nations peoples. We reviewed national, state, and territory-level health policies, including documents from both Aboriginal Community Controlled and mainstream services, to identify critical gaps, challenges, and opportunities for improving prevention, early intervention, and treatment of EDs in First Nations communities. While our initial intent was to focus on culturally specific services, the majority of included documents following our revised search strategy came from mainstream policy sources, underscoring the limited attention this issue receives within First Nations-led frameworks.
What We Found: Barriers and Drivers
We identified 398 eligible documents; after double screening by two researchers, 19 documents were included in our review. Our analysis revealed a distinct need for recommendations for the prevention and management of EDs specific to First Nations peoples. The included documents focus on (a) the potential drivers for EDs, (b) the significant research deficit, and (c) recommendations for future research to inform practice. We found that policy documents were largely silent on how to prevent or respond to EDs among First Nations peoples in the here and now, generally saying that more research would be needed before recommendations could be made. A thematic analysis was conducted on the 19 included documents and four key themes were identified (see Figure 3).
Below is a snapshot of the key issues and drivers our review identified:
Socioeconomic Disadvantage – First Nations peoples face higher rates of poverty, food insecurity, and limited access to mental health services, particularly in rural and remote areas. For example, over one in five First Nations people have experienced food shortages, impacting mental wellbeing.
Healthcare Access Gaps – Many First Nations people struggle to access affordable, culturally safe treatment. Barriers include service shortages, high out-of-pocket costs, and a lack of culturally trained professionals.
Colonisation and Food Systems – Colonisation disrupted traditional food systems, leading to dietary changes linked to poorer health. Loss of cultural food practices is seen as both a driver of disordered eating and a loss of protective cultural identity.
Trauma and Dispossession – Intergenerational trauma, grief, and disadvantage continue to affect First Nations communities. These factors, combined with cultural disconnection, increase the risk of eating disorders.
Research and Awareness Gaps – While research has begun to establish likely prevalence of EDs among First Nations peoples – with one 2020 study finding rates as high as 27% for adults and 29% for adolescents, exceeding those from non-Indigenous groups – the next step is clear. We must move beyond identifying the problem and urgently address the lack of culturally appropriate screening tools, treatment models, and targeted initiatives. Without these, awareness remains low, and care outcomes continue to fall short.
Protective Cultural Strengths – Connection to culture, family, Country, and community are protective factors. Strengthening these connections through culturally safe services can support prevention and recovery.
Moving Forward
This review reinforces what many have known for a long time, that EDs are not absent from First Nations communities, but they are overlooked. While research has established a likely high prevalence, we now need to go beyond the numbers. There is an urgent need to develop culturally safe screening tools, treatment models, and services co-designed with First Nations peoples. We must move from identifying the problem to actively transforming systems. This means funding research led by First Nations peoples, embedding cultural knowledges into policy and practice, and prioritising approaches that strengthen protective factors like connection to culture, Country, kinship, and identity.
Encouragingly, this research has already contributed to change. A companion resource, First Nations Perspectives: Strengthening the Eating Disorder Safe Principles, has been developed to guide and improve culturally safe care. This resource supports services and practitioners to reflect, learn, and act to ensure their work aligns with the values and needs of First Nations communities.
As a Truwulway woman and a researcher working within public health systems, I carry both lived experience and responsibility in navigating the colonial structures that shape our understanding of health and wellbeing. This work comes from a place of care for community, for justice, and for futures where culturally grounded models of care are not an afterthought but the foundation. While this review is grounded in evidence, it is also shaped by the belief that First Nations peoples deserve systems built with, not just around them.
I hope this work helps spark action, not just more reading and more discussion, but real shifts in how we think about and provide care. I hope researchers, clinicians, and decision-makers take the time to listen deeply, reflect on their own practice, and use these resources to begin reshaping systems in partnership with First Nations communities. My wish is that the next time we talk about eating disorders and First Nations peoples, it’s not from a place of absence or invisibility, but of strength, support, and self-determination.
Get support
For support with eating disorders or body image issues, connect with the Butterfly National Helpline for confidential and free support, by calling 1800 ED HOPE (1800 33 4673) or visit www.butterfly.org.au to chat online or email, 7 days a week, 8am-midnight AEST.
You can also reach out to 13YARN on 13 92 76, a free 24/7 crisis support line that is led by, developed and delivered by Aboriginal and Torres Strait Islander peoples for Aboriginal and Torres Strait Islander peoples.
